Blood pressure (OSCE)

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Taking a Blood Pressure

Contents 1 General 2 Equipment 3 Positioning 4 Placement 5 Performance 6 Pitfalls 7 Classification 8 Other OSCE modules

[edit] General

• No:
  • smoking or caffeine x 30 mins
  • constrictive clothing

• Yes:
  • rest for ≥ 5 minutes
  • breathing normal and relaxed

• During recording: no talking and patient’s legs uncrossed

[edit] Equipment

• cuff size
  • bladder width > 40 % of arm circumference
  • length > 80% of arm circumference

[edit] Positioning

• Level: devices and columns at eye level, patient’s arm held at heart level

[edit] Placement

• lower edge of cuff ~ 3 cm above elbow crease
• bladder centered over brachial artery (palpate medial to biceps tendon)

[edit] Performance

• palpate radial pulse (note arrythmias)
• inflate cuff to ~ 30 mm Hg above palpable pulse
• drop the pressure by 2 mm Hg / second (prolonged filling will lead to venous congestion, making the sounds harder to hear)
• repeat after ≥ 2 minutes of standing to assess for orthostatic hypotension (drop in 20/10)

• for all patients on the first visit, take at least 2 readings separated by 2 minutes
  • if first 2 readings differ by > 5 mm Hg, another reading is indicated
  • Elevated readings should be confirmed on 3 readings

[edit] Pitfalls

• anxiety, pain
• arrhythmias
• wrong cuff size (too small overestimates, too large underestimates)
• Isolated office hypertension ('white coat' hypertension) (up to 25%)

[edit] Classification

(criteria for adults > 17 and not taking antihypertensives)

• Optimal < 120/80
• Normal < 130/85
• High Normal < 140/90
• Hypertension Stage 1 < 160/100
• Hypertension Stage 2 < 180/110
• Hypertension Stage 3 < 210/120
• Hypertension Stage 4 > 210/120

[edit] Other OSCE modules